New Rules For ‘Obamacare’ Scrutinized By Insurers, Employers, States, Consumers

Long-awaited draft regulations offer new guidance to insurers, states and employers.

USA Today: Administration Unveils Health Care Regulations
The Obama administration released new health care regulations Tuesday that preclude insurers from adjusting premiums based on pre-existing or chronic health conditions, tell states what benefits must be included in health exchange plans, and allow employers to reward employees who work to remain healthy (Kennedy, 11/20).

The Washington Post: Obama Administration Officials Propose Altered Rules For Health Insurers
The Obama administration proposed new rules Tuesday that would loosen some of the 2010 health-care law’s mandates on insurers while tightening others. Certain health plans, for instance, would be able to charge customers higher deductibles than originally allowed under the legislation. But all plans would be required to cover a larger selection of drugs than under an earlier approach outlined by the administration (Aizenman, 11/20).

The New York Times: Administration Defines Benefits That Must Be Offered Under The Health Law
The proposed rules, issued more than two and a half years after President Obama signed the Affordable Care Act, had been delayed as the administration tried to avoid stirring criticism from lobbyists and interest groups in the final weeks of the presidential campaign (Pear, 11/20).

Los Angeles Times: Administration Affirms Key Mandates Of Healthcare Law
Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law’s requirements as the federal government races to implement the legislation by the end of next year. But the proposed rules issued Tuesday hew closely to the Affordable Care Act (Levey, 11/20).

Kaiser Health News: Administration Releases New Health Law Rules For Insurers, Employers
[A] quick review showed that no one group won everything it wanted. For example, insurers did not succeed in getting the government to phase-in a requirement that limits their ability to charge older applicants more than younger ones. And consumer groups, which wanted specific details on the benefits required in 10 broad categories, instead saw continued discretion given to state regulators to pick “benchmark” plans and benefits (Appleby, Hancock and Carey, 11/20).

The Wall Street Journal: States Get A Say In Health Law
The federal government also expanded requirements for prescription-drug coverage from previous proposals, but it left states with different options to choose from, as well as responsibility for enforcement. Some employer groups praised the rules for keeping new plan benefits in line with what is already offered by small businesses. But the insurance industry said the rules didn’t go far enough to keep insurance costs down, particular for younger consumers (Radnofsky, 11/20).

Modern Healthcare: HHS Releases Proposed ACA Insurance Regulations
Starting in 2014, the Patient Protection and Affordable Care Act will make it illegal for health insurance companies to discriminate against people who have pre-existing conditions, which HHS estimates affect some 129 million nonelderly Americans. In the proposed rule, health insurance issuers would generally be barred from denying coverage for such conditions, and individuals would have new special enrollment opportunities in the individual market when they have certain losses of other coverage (Zigmond, 11/20).

NPR: Administration Lays Down Rules For Future Health Insurance
[T]he administration is laying out rules to govern the use of employer-provided “wellness programs.” These popular programs encourage employees to meet certain health goals, such as losing weight, quitting smoking, or lowering cholesterol. The rules spell out that programs must not be “overly burdensome” and must provide a “reasonable alternative means of qualifying for the reward” for individuals whose medical conditions “make it unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health-related standard” (Rovner, 11/20).

Kaiser Health News: Obama Administration Gives Smokers A Way Out Of Higher Insurance Premiums
[The rules] effectively nullified a provision of the federal health law that would have allowed insurers in the small group market to charge smokers up to 50 percent more than nonsmokers. Under the proposed regulation, employees who use tobacco can avoid paying those higher premiums if they participate in a program to quit (Galewitz, 11/20).

The Associated Press: HHS Details Overhaul Rules And Required Benefits
Having the federal government set minimum standards for what health insurance must cover is a departure from normal practice. Usually, insurance companies, their state regulators and employers play that role. But the Affordable Care Act requires that Washington establish a baseline for minimum coverage in areas that include inpatient and outpatient care, emergency services, maternity and childhood care, prescription drugs, preventive screenings and lab work (Murphy, 11/20).

The Hill: HHS Releases Health Law Rules Requiring Pre-Existing Conditions Coverage
The regulations still leave key questions unanswered, including the structure of a federally run insurance exchange in the roughly 30 states that won’t set up their own. HHS officials said more information on the federal exchange will be coming soon. … While the new rules don’t answer some questions for states, they do provide much-needed specifics for insurance companies that must prepare for new mandates set to take effect in 2014 (Baker, 11/20).

Medpage Today: HHS Proposes Rules On Key Parts Of ACA
The rules also mandate that insurers maintain separate statewide risk pools for the individual and small-employer markets, unless a state wants to combine the two. Premiums and rate changes would be based on the health risk of the entire pool (Pittman, 11/20).

McClatchy: Insurers’ Duties Under Health Care Law Taking Shape
The rule’s final provision insures that young adults and people who can’t afford insurance will have access to catastrophic health coverage in the individual insurance market. Many of today’s proposed rules will help “ensure that consumers are protected from some of the worst insurance-industry practices,” [Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services] said (Pugh, 11/20).

Politico Pro: Essential Benefits Rule: No Surprises, Some Gaps
The health care industry waited 11 months for the Obama administration’s follow-up act to its essential health benefits bulletin. For many, Tuesday’s EHB proposed rule felt like a repeat performance. Credit the administration’s bulletin last year for spelling out what the proposed rule itself would look like. States will get to set benefits from a choice of certain plans, insurers will have some flexibility and HHS will be there watching over it all in some capacity (Millman, 11/20).

Politico Pro: HHS To States: Costs Of New Rules ‘Minor’
In a section of its proposed rule titled “Costs to States,” HHS estimates that although states “may need additional resources” to ensure that health plans in their exchange meet minimum coverage requirements, “these costs will be relatively minor.” In the rule, HHS also notes that federal law prohibits Washington from imposing an “unfunded mandate” on states in excess of $139 million in a given year (Cheney, 11/20).

CQ HealthBeat: Lots Of Regs, But What About The Federal Exchange?
Missing from Tuesday’s massive release of hundreds of pages of proposed rules filling in the details of the sweeping redesign of the insurance market, set in motion 32 months ago by passage of the health care law, were details on an entity looming ever larger in delivering the fruits of that legislation: the federally facilitated exchange. By the end of the day, however, it appeared that officials had made considerable progress on the regulatory front, with insurers and states now having to scramble to conform to the new mandates (Reichard, 11/2).

CQ HealthBeat: Obama Administration Rolls Out Proposed Rule On Insurance Market Changes
The long-anticipated next steps in a complicated regulatory dance involving the federal government, states and health insurers were laid out by the Obama administration on Tuesday, and federal officials acknowledged that there is much more work ahead (Norman, 11/20)

CQ HealthBeat: Essential Health Benefits Proposal Gives States Flexibility, Expands Prescription Drug Requirements
The proposed rule also included standards on how the actuarial value of plans would be determined. Separately, the Centers for Medicare and Medicaid Services issued a guidance to states on the types of benefits that Medicaid programs must include if they expand coverage under the health care law. Under the essential benefits proposed rule, health plans in the individual and small-group markets — both in and outside of the new exchanges — would have to provide coverage in the 10 categories of services that the health care law requires (Adams, 11/20)

CQ HealthBeat: Proposed Rule Sets Standards For Wellness Programs
[T]he maximum permissible rewards would increase in 2014 from the current ceiling of 20 percent of the cost of health coverage to 30 percent. However, the proposed regulation says that when it comes to programs designed to prevent or decrease tobacco use, the maximum reward could be increased to as much as 50 percent (Reichard, 11/20).

Reuters: U.S. Releases New Health Insurance Reform Rules
The proposed measures were likely to come under fire from healthcare reform opponents including a growing number of Republican governors who have rejected the provisions calling on states to operate their own healthcare exchanges beginning January 1, 2014. States have until December 14, under a newly extended deadline, to tell the Department of Health and Human Services whether they intend to pursue their own healthcare exchanges (Morgan, 11/20).

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